Endocrine

Question 1

Levothyroxine is a replacement for

Answer 1

T4

Question 2

Why is levothyroxine better than liothyronine

Answer 2

Requires less frequent dosing and has a lower risk of causing thyrotoxicosis

Question 3

What is levothyroxine dosed in and how is it administered

Answer 3

mg/kg orally BID

Question 4

How long after starting therapy should you start measuring T4 levels

Answer 4

4 weeks

Question 5

What drugs could interfere with thyroid test results

Answer 5

Phenobarbital, zonisamide, glucocorticoids, phenylbutazone, quinidine

Question 6

What is the only veterinary approved thyroid drug

Answer 6

Thyro tabs

Question 7

What are the three pharmalogical ways to treat hyperthyroidism

Answer 7

Prevent production
Prevent release of preformed hormone
Prevent conversion of T3 to T4 in tissues

Question 8

Methimazole is a ____ and inhibits ____

Answer 8

Thioureylene

Hormone synthesis

Question 9

Methimazole is consistently ___ and side effects are ___

Answer 9

Efficacious

Uncommon and most are manageable

Question 10

What are the mild/common side effects of Methimazole

Answer 10

GI signs (vomiting), transient hematologic changes on CBC

Question 11

What are the severe/uncommon side effects of Methimazole

Answer 11

Refractory GI signs, idiosyncratic reactions (facial excoriation, hepatopathy, bone marrow suppression)

Question 12

What are the forms of Methimazole

Answer 12

Tapazole, felimazole, transdermal methimazole

Question 13

What are the parenteral calcium options and when would they be given

Answer 13

Ca Gluconate, Ca Choloride

Emergency Acute Hypocalcemia

Question 14

Ca Chloride is ____ and should never be given ___

Answer 14

Caustic, SQ/IM

Question 15

Rapid IV administration of Calcium can cause

Answer 15

Arrhythmias

Question 16

Why should Ca Chloride and Ca Gluconate be given IV

Answer 16

So they are immediately diluted and don’t sit one spot for long periods of time

Question 17

What are the Oral Ca options for chronic hypocalcemia

Answer 17

Ca Carbonate, Ca Proprionate

Question 18

What is required when giving oral calcium

Answer 18

GI tract must be able to absorb the calcium

Question 19

What causes the GI tract to not be able to absorb calcium

Answer 19

No PTH (hypoparathyroidism)
Vitamin D is not converted to calcitriol

Question 20

What is given to increase calcium absorption

Answer 20

Calcitriol

Question 21

Calcitriol is the _____ activated form of vitamin D and is the most ____

Answer 21

Most potent activated form of Vitamin D and is the most rapid

Question 22

What is the biggest potential side effect of calcitriol

Answer 22

Hypercalcemia

Question 23

How can dextrose be administered

Answer 23

Orally
Intravenous bolus in emergency (50% diluted 1:4)
Ongoing IV (5% concentration)

Question 24

How is glucagon adminitered and in what measurement

Answer 24

IV injection - nanograms

Not commonly used

Question 25

What is the equation to determine amount of stock to add

Answer 25

% desired over % stock times volume in bag

Question 26

What is the primary goal of DM therapy

Answer 26

Address insulin deficiency not to bring down blood glucose

Question 27

Oral hypoglycemic agents cause ___

Answer 27

hypoglycemia, they don't treat it

Question 28

The only clinically relevant oral hypoglycemic drug is

Answer 28

Glipizide

Question 29

Glipizide is used for ____ and only in ____

Answer 29

Type II diabetes in cats

Question 30

Mechanism of Action of Glipizide

Answer 30

Stimulate insulin secretion by the pancreatic beta cells by blocking K channels Increase tissue sensitivity to insulin

Question 31

Insulin is produced by

Answer 31

Beta cells of the islets of Langerhans in the endocrine pancreas

Question 32

Exogenous Insulins are all given by

Answer 32

Injection (IV, SQ, IM)

Question 33

What are the different durations of action for exogenous insulin

Answer 33

Short, Intermediate and Long acting

Question 34

The potency of various formulations is usually very similar except for ___

Answer 34

detemir - 4x higher

Question 35

What is the only insulin that can be given IV

Answer 35

Regular insulin

Question 36

Regular insulins duration of action is ___ and is usually used for

Answer 36

Short acting | Used for hospitalized patients that aren't eating

Question 37

What are the intermediate acting insulins

Answer 37

NPH, vetsulin/caninsulin

Question 38

How are intermediate acting insulins given

Answer 38

SC only

Question 39

Vetsulin/Caninsulin is good for

Answer 39

Good starting insulin for dogs

Question 40

What are the long acting insulins

Answer 40

Protamine Zinc, Glargine and Detemir

Question 41

How are long acting insulins given

Answer 41

SC Only

Question 42

Which drug forms microprecipitates in physiologic pH which results in very gradual absorption

Answer 42

Glargine

Question 43

Which drug is a veterinary approved product and may have a shorter duration particularly in cats

Answer 43

PZI - Protamine Zinc

Question 44

What are the only two mineralcorticoids

Answer 44

Fludrocortisone and DOCP

Question 45

Where are glucocoirticoids produced

Answer 45

zona fasciculata

Question 46

What are the Glucocorticoid drugs

Answer 46

Prednisone, dexamethasone, triamcinolone, methylprednisolone

Question 47

Glucocorticoids are used for their _____ effects

Answer 47

anti-inflammatory

Question 48

Glucocorticoid Non-genomic effect

Answer 48

Glucocorticoid receptors in the membrane - rapid effects

Question 49

Glucocorticoid Genomic effects

Answer 49

Nuclear type GCRs in the cytoplasm - increase or decrease gene expression

Question 50

Physiological Effects of Glucocorticoids

Answer 50

Increase calcium excretion Reduce fever Suppress immune response Lymphotoxic

Question 51

Adverse Effects of Glucocorticoids

Answer 51

PU/PD, Catabolic, antagonize insulin, inhibit fertility, stress leukogram, Increase GI acid and decrease mucus

Question 52

Clinical uses for glucocorticoids

Answer 52

Diagnostic testing Physiologic Replacement Therapy (Addison's) Anti-inflammatory (allergies) Immunosuppressive

Question 53

Glucocorticoids are well absorbed ___ or ____

Answer 53

Orally or Parenterally

Question 54

Glucocorticoids are ___ bound

Answer 54

Protein

Question 55

The specific transporter for glucocorticoids is ____ and it has a ____ affinity and ____ capacity

Answer 55

Transcortin | High Affinity and Low Capacity

Question 56

The secondary transport for glucocorticoids is ____ and it has a ____ affinity and ____ capacity

Answer 56

Albumin | Low Affinity and High Capacity

Question 57

Which glucocorticoids are Pro-drugs and must be hydrolyzed

Answer 57

Prednisone --> prednisolone Cortisone --> Cortisol Methylprednisone --> methylprednisolone

Question 58

Metabolites are excreted in ___

Answer 58

Urine

Question 59

List Glucocorticoids in order of potency

Answer 59

Cortisol, Prednisone, Tramcinolone, Dexamethasone

Question 60

What are the salt esters

Answer 60

Succinate and phosphate

Question 61

What are the insoluble esters

Answer 61

Pivalate, acetate and acetonide

Question 62

What do salt esters do

Answer 62

Make steroid soluble and suitable for IV administration

Question 63

Salt esters the onset may be ___ but duration is ____

Answer 63

Onset may be faster but duration is unchanged

Question 64

Insoluble esters ___ onset and have a ____ duration

Answer 64

Delayed onset and long duration | Less soluble the ester the longer it will take to absorb

Question 65

Opaque suspensions cannot be give by ___

Answer 65

IV

Question 66

Short Term (3-5 days) Side Effects of glucocorticoids

Answer 66

Not serious Stress leukogram, decreased thyroid PU/PD Fetal abnormalities/abortion

Question 67

Long term (> 1 wk) Side Effects of Glucocorticoids

Answer 67

Susceptibility to infection Skin changes (collagen disease, delayed wound healing) Hypertension Latrogenic Addison's

Question 68

Where are mineralcorticoids produced

Answer 68

Zona glomerulosa

Question 69

What do mineralcorticoids regulate

Answer 69

Na retention and K excretion by the kidney

Question 70

How is Fludrocortisone given

Answer 70

Orally BID

Question 71

How is DOCP given

Answer 71

Parenterally (IM, SC)

Question 72

What is Typical Addison's

Answer 72

Lacking both glucocorticoids and mineralcorticoids

Question 73

What drugs are needed for typical addison's

Answer 73

prednisone and DOCP/Fludrocortisone

Question 74

What is atypical addison's

Answer 74

Lacking just glucocortocoid

Question 75

What drug is needed for atypical addison's

Answer 75

just prednisone